@article {Dhooria700, author = {Sahajal Dhooria and Inderpaul Singh Sehgal and Ashutosh N Aggarwal and Digambar Behera and Ritesh Agarwal}, title = {Diagnostic Yield and Safety of Cryoprobe Transbronchial Lung Biopsy in Diffuse Parenchymal Lung Diseases: Systematic Review and Meta-Analysis}, volume = {61}, number = {5}, pages = {700--712}, year = {2016}, doi = {10.4187/respcare.04488}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Transbronchial lung biopsy with flexible forceps is the most commonly used technique in diagnosis of diseases diffusely involving the lung parenchyma. Recently, transbronchial lung biopsy using the flexible cryoprobe (cryo-transbronchial lung biopsy) has also been reported. Herein, we perform a systematic review and meta-analysis describing the efficacy and safety of cryo-transbronchial lung biopsy.METHODS: The PubMed and EMBASE databases were searched for studies reporting the outcomes of cryo-transbronchial lung biopsy in subjects with diffuse parenchymal lung involvement. The quality of individual studies was assessed using the QualSyst tool. The pooled diagnostic yield of cryo-transbronchial lung biopsy was calculated using proportion meta-analysis (random effects model). Heterogeneity was evaluated using the I2 test and Cochran Q test. Publication bias was determined using both statistical and graphical methods.RESULTS: Our search yielded 14 studies (1,183 subjects). The pooled diagnostic yield of cryo-transbronchial lung biopsy was 76.9\% (95\% CI 67.2{\textendash}85.3) if only definitive diagnoses were considered and 85.9\% (95\% CI 78.2{\textendash}92.2) if both definitive and probable diagnoses were considered. Four studies (321 subjects) the performance of flexible forceps biopsy and cryo-transbronchial lung biopsy. The diagnostic yield of cryo-transbronchial lung biopsy (86.3, 95\% CI 80.2{\textendash}90.8) was significantly higher than that of flexible forceps biopsy (56.5\%, 95\% CI 27.5{\textendash}83.2) with an odds ratio of 6.7 (95\% CI 3.6{\textendash}12.4) and a number needed to treat of 4. Lung tissue was obtained in 98\% of all samples with cryo-transbronchial lung biopsy and was free of compression artifacts. The size of samples obtained with cryo-transbronchial lung biopsy was significantly bigger compared with flexible forceps biopsy (20.4 vs 4.3 mm2, P = .005). The complications of cryo-transbronchial lung biopsy included pneumothorax (6.8\%), severe bleeding (0.3\%), and death (0.1\%). Clinical and statistical heterogeneity was present, and there was evidence of publication bias.CONCLUSIONS: Cryo-transbronchial lung biopsy is a relatively safe procedure with good diagnostic yield in diseases diffusely involving the lung parenchyma.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/61/5/700}, eprint = {https://rc.rcjournal.com/content/61/5/700.full.pdf}, journal = {Respiratory Care} }